A new wearable e monitoring technology for evaluation of left ventricular remodeling after transcatheter aortic valve replacement.

Abstract

Aims: Pathological left ventricular (LV) remodelling following aortic stenosis (AS) confers high risk for heart failure and significantly decreases survival. This study aims to introduce a new wearable acoustic cardiography (ACG) device measuring electromechanical activation time (EMAT) to identify the regression of cardiac remodelling in AS patients undergoing transcatheter aortic valve replacement (TAVR).

Methods and results: This prospective cohort study consecutively enrolled patients with severe symptomatic AS who underwent successful TAVR. The parameters EMAT and EMAT% (EMAT divided by R-R interval, expressed as a percentage) derived from ACG as well as echocardiography data were collected. Pearson correlation analysis was performed to evaluate the correlation between EMAT% and left ventricular mass index (LVMi). Receiver operating characteristic (ROC) curves were used to assess the diagnostic performance of EMAT% in predicting left ventricular hypertrophy (LVH). A total of 159 patients (mean age 72.0 years) were enrolled in the study. At baseline, 55% of patients demonstrated severe LV remodelling. Scatter plots and Pearson correlation analysis revealed a significant association between EMAT% and LVMi. The ROC curve analysis showed strong diagnostic performance of EMAT% in predicting LVH, with an area under the curve consistently exceeding 80% at baseline and during follow-up. Both EMAT% and echocardiographic parameters indicated that LV remodelling progressively improved between 1 and 6 months after TAVR, with stabilization observed at 12 months.

Conclusion: The EMAT can be considered as an effective tool to assist in the evaluation of LV remodelling after TAVR. Further studies are required to confirm its utility as a valuable non-invasive diagnostic and monitoring tool.